Taxanes — Taxanes are among the most active agents for metastatic breast cancer – Docetaxel, Paclitaxel, NabPaclitaxel. Anthracyclines – Doxorubicin, Epirubicin, Caelyx. Capecitabine / 5 FU Eribulin Vinorelbine Gemcitabine Ixabepilone Etoposide Cyclophosphamide Methotrexate Platinum agents Combination Chemotherapy High Dose Chemotherapy and Stem Cell Transplant – no benefit.

Common Adjuvant Regimens First Generation → Second Generation → Third Generation CMF*6 → CAF*6, CEF*6 CMF*6 → FAC*6 → TAC*6 CE(50)F*6 → CE(100)F*6 → FEC*3 →D*3 AC*4 → AC*4 → Txl*4 q3wk → Dose Dense (CA*4 → Txl*4 q2wk) AC*4 → TC*4 20%

RANDOMIZERANDOMIZE Doxorubicin 60 mg/m2 IV Day 1 Cyclophosphamide600 mg/m2 IV Day 1 Every 21 days x 4 cycles Docetaxel 75 mg/m2 IV Day 1 Cyclophosphamide600 mg/m2 IV Day 1 Every 21 days x 4 cycles

4 2 nd Generation Adjuvant Chemo Trials First Generation → Second Generation → Third Generation CMF*6 → CAF*6, CEF*6 CMF*6 → FAC*6 → TAC*6 CE(50)F*6 → CE(100)F*6 → FEC*3→D*3 AC*4 → AC*4 → Txl*4 q3wk → Dose Dense (CA*4 → Txl*4 q2wk) AC*4 → TC*4

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8 What’s the Goal? Select patients who will require systemic therapy Find predictive factors (either before or early in treatment) that allow for accurate tailoring of therapy

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